Episode 67: Reclaiming Health: Julie’s GLP-1 Journey Beyond the Scale

In this episode of the Pound of Cure Weight Loss Podcast, Julie shares her transformative journey with weight loss, detailing her struggles with insurance, medication, and the emotional toll of her experiences. She discusses the challenges of finding the right dosage of GLP-1 medication, the positive side effects she has experienced beyond weight loss, and the importance of understanding inflammation in weight management. Julie emphasizes the need for a supportive healthcare system and the liberation she feels from finally being in control of her health and relationship with food.

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Transcript

Zoë (00:20)
Hello and welcome back to the Pound of Cure Weight Loss Podcast. We are very excited to welcome our patient today to share her story, Ms. Julie. Welcome.

Julie Pratt (00:31)
Hi, thank you for having me.

Matthew Weiner, MD (00:31)
Hi, Joey.

Zoë (00:33)
How's your day going so far?

Julie Pratt (00:35)
It's a good day, sunny and warm. So it's Friday. ⁓

Zoë (00:38)
And it's Friday. ⁓

Matthew Weiner, MD (00:40)
Yeah,

there's nothing better than a Michigan summer and very few things worse than a Michigan winter. But man, the summer's a great year. Yeah, yeah. For us Arizona, it's flipped. Like this is our rough time. Yeah, it's probably 105 degrees out right now.

Julie Pratt (00:43)
Yes.

True.

Zoë (00:49)
Make you earn it make you earn that summer.

Julie Pratt (00:51)
Yes.

Okay.

Zoë (00:59)
And that's just getting started.

So Julie, tell us a little bit about your, first off, how you came to be a patient with our practice. And we'd love to hear a little bit about that and then we can dig into your story.

Matthew Weiner, MD (01:03)
I'll see you next

Julie Pratt (01:14)
So I started almost a year ago. So it was like early summer last year that I ⁓ kind of gave into my initial protest to using a GLP-1 after many years of weight issues ⁓ and decided I was going to try it. And I started initially my insurance covered and I started on tersepidide. I immediately had a pretty good response with minimal side effect at.

pretty low dose, two and a half milligrams. And I stayed on that for as many months as my insurance would let me. Unfortunately, the way my insurance worked is they made me go up every month, regardless of the amount of weight loss. ⁓ I went into it with the philosophy of I wanted to lose slow, because I have a huge fear of like skin sagginess. And I really wanted to do sustainable ⁓ like.

Matthew Weiner, MD (01:52)
Okay.

Julie Pratt (02:09)
change things and have this be as sustainable as possible. So I wanted to do a very slow loss. So I wanted to stay on a very low dose. My insurance would make me every month go up. And every time I went up, I had horrible side effects and I would have to stop for a little while, let my body calm, chill, and then start again. I was working with my primary care who

is absolutely wonderful, very supportive, and she had helped me for many years with my weight loss struggle and knew how hard I was working at it. So she was supportive, but didn't have a great amount of knowledge in what to change or do different when I was hitting these significant side effects. ⁓ And then my insurance would, every about three months, stop and decide they weren't going to cover and make me prove all kinds of things like

send exercise logs, send food logs, send everything under the sun that I had tried. ⁓ And they would then authorize it. So I would do like three months on with one of those months with severe side effects. Then I'd be off for a month or two and start all over again. ⁓ I even did weird things to try to keep my dose low. Like when they put me on seven and a half milligrams, I like would click the pen and then try to like pull the pen out early and be like.

I don't know how much is in there, but at least it's not seven and a half. I don't want to be sick this, and I was fine on five, right? So I would do these bizarre things to attempt to be at a dose that I felt was effective for me without side effects. ⁓ And then my insurance announced at the new year that they would no longer cover for weight loss no matter what. My doctor did an amazing job of attempting to appeal because I was pre-diabetic about a year ago.

Zoë (03:26)
Thank

Matthew Weiner, MD (03:30)
⁓

Julie Pratt (03:53)
⁓ I have been treated with metformin for PCOS the majority of my adult life. And so we felt like there were other comorbidities and things happening that I was getting help from ⁓ with the medication, but my insurance declined. So I paid for a couple of months out of pocket. ⁓ But of course, like couldn't like wanted to get five milligram pens and

was paying out of pocket $650 a month, then ⁓ that was not sustainable for us as a family. ⁓ Two kids in college and that just was not sustainable. ⁓ Yeah. So ⁓ I started doing research on compounding. ⁓ I really did not want to go the route of compounding. Number one, knowing what I had heard on your podcast and on other podcasts that I listened to.

Matthew Weiner, MD (04:31)
And this was before Lily Direct, right?

Julie Pratt (04:50)
I knew that there would be an end to compounding and I was having such amazing results. And in addition to weight loss, improvements that I am happy to share too, ⁓ that I knew I didn't want it to end. So I was trying to figure out a way, some way to do the non-compounded. ⁓ I also didn't fully trust the compounding industry. I feel like I don't.

know exactly what I'm getting and I was a little concerned about that. So ⁓ did a lot of research. ⁓ I had been listening to your podcasts and my sister-in-law had actually recommended that I start listening to your podcast long before I took the GLP-1 because I was anti GLP-1 and I was anti surgery. Even though at 50 years old, I have died in my entire adult life and fought this battle. So my sister-in-law had encouraged me to

Matthew Weiner, MD (05:42)
All right.

Julie Pratt (05:46)
look at your book, to look at Pondichir, to listen to the podcast. And so I had a friend who was using GLP-1 in between talking with her and listening ⁓ is when I decided to try it. So I kind of went back to some of your resources and had seen the platinum program come through on an email and decided I would do try this and then met with you guys to see if I could make, you know, ZepBound not using compounded.

and working with a physician and practice that knew more specifically about my weight loss if I would have more success. So that's how I ended up here.

Matthew Weiner, MD (06:16)
Yeah.

Well, we're glad to have found you. ⁓ You know, I'm going to go on a little bit of an insurance rant right now, so buckle up. ⁓ But, you know, really, your insurance company was playing doctor by mandating that you increase the dose. Now, their rationale came from the surmount trial where they had a very steady stepwise increase in the dose.

Zoë (06:25)
That's great.

Julie Pratt (06:27)
Thanks.

Yes.

Matthew Weiner, MD (06:51)
And essentially what they said was that an initial FDA trial, so you got to realize what was the purpose of the surmount trial? Was it research to figure some piece of medical information out? Absolutely not. It was designed 100 % with one purpose in mind and that was to obtain FDA approval for the medication. That was the intent of the study. The study was designed for that purpose and they raised the dose up to make sure that

people didn't have a slower weight loss and so that they would be able to demonstrate efficacy. And I get why they did it. wasn't I don't blame them for it at all. mean, that's the rules and you got to play by the rules and the rules actually are not perfect, but they work for the most part when it comes to FDA approval. ⁓ But then for the insurance companies to extract from that and take away the clinical judgment of the doctor who is seeing that patient when you see a patient is like,

I'm puking all day long, I feel terrible. And any doctor worth anything would say, don't take as much, let's go down, you're taking too much, let's decrease the dose. And the insurance company restricts that physician's ability to treat the patient. And I think that is a very dangerous precedent. And we won't see that a lot, but in obesity,

Julie Pratt (08:09)
Right.

I agree.

Matthew Weiner, MD (08:18)
The society has given insurance companies and really anybody a lot more leeway to be discriminatory. If you mandated that a cancer patient follow a specific protocol for treatment of their cancer and go up on the dose, even if the cancer patient was having toxic side effects, there would be outrage, absolute outrage.

Julie Pratt (08:26)
Mm-hmm.

Right, well,

not only toxic side effects, but success with less dose. Like I kept saying to the insurance company, why would you want to pay for and provide me more medication when I'm succeeding with less? Like it made no sense.

Matthew Weiner, MD (08:48)
Right.

Yeah.

And initially, and I will tell you also, the way that we figured out, and we're going to talk about what we did together that works.

Julie Pratt (09:07)
Okay.

Matthew Weiner, MD (09:08)
The way that I figured that out was I had these patients just like you where the insurance was like, sorry, you got to go up to 7.5. And the patient was saying, please, no, I can't. And I was like, okay, here's what we're going to do. And so why don't you talk through how you're doing it? We actually, I'll talk a little bit later. We have an even better way that we're doing it now, but talk through about how, what we came up with and how it worked out for you. So. ⁓

Julie Pratt (09:19)
Yeah.

one.

Yeah. So, ⁓

at the time I came into your practice, I had been off of the medication for a couple of months then because of the denial and my research and trying to figure out how to move things forward. ⁓ so we did, went through my intake with you, all my history and the success that I was having on trisepatide, did the prescription and went through my pharmacy with the coupon from Lilly. so it,

It was about $650 still, but we did the 15 milligram pens. And then we took the 15 milligram pens, emptied them into the vial. And I don't know if you remember this or not, Dr. Weiner, but I had like, it was like a meltdown because the first time I tried it, the needle hit the side of the vial and like wouldn't release the medication to the vial. just spilled all over my countertop. And I was like bawling. My husband was like, this isn't that big of a deal. I'm like,

It's so much money in that, look that was liquid gold and I need it in my body. I just want this medication back in my body because it was, in addition to weight loss, I get so many other good benefits from it and so I just really desperately wanted to be back on the medication. So we figured that out, you helped me conquer that, we tried different vials. ⁓ My husband figured out how to like...

Zoë (10:37)
Like licking it up.

Julie Pratt (10:59)
you know, take the medication out of the actual pen and it's much easier. It's a super easy process. And then what I like is I didn't have to make the jump from two and a half to five and feel miserable again. We did a very slow, so we did two and a half for a little while. I was losing about a pound a week and then I kind of plateaued and was having not as good of, ⁓ I guess it's a side effect to get the relief from the food noise and those kinds of things.

Zoë (11:25)
response.

Matthew Weiner, MD (11:26)
I'm tired

here.

Julie Pratt (11:27)
Yeah, getting a more positive response. And so we went up, but the great part was is the way we're doing it, I was able to go up to like three and a half and four and I kind of maintained, I stay right around for a week, four milligrams. I don't know what the, now it is milligrams, not milligrams. I don't know the measurement, but that has been wonderful for me because if I'm having more side effects, like I...

Matthew Weiner, MD (11:45)
No answer.

Julie Pratt (11:55)
feel a little nauseous that week, I'll do three and a half on that week instead of four. If I'm starving, last week I was like starving all week and I couldn't figure out why and I didn't feel like I had changed anything, I did five. And so I stay under five all the time and I'm pretty consistently losing a pound to a pound and a half a week with minimal to no negative side effects at that door.

Matthew Weiner, MD (12:22)
So how much does this

Zoë (12:22)
That's amazing.

Matthew Weiner, MD (12:22)
medicine

cost you?

Julie Pratt (12:24)
So for four pens with the coupons, which I think I have a year of coupons through Lilly, is $650 at my pharmacy.

Matthew Weiner, MD (12:33)
And at five milligrams, that'll last you three months.

Julie Pratt (12:36)
Correct, so one pen is three months, so the four pens is what, is that 12 weeks, I think? Is that right? Three weeks, yeah. So four pens, yeah, yeah.

Matthew Weiner, MD (12:40)
Now, one pen is three weeks. So four pens is give or take three months, 12 weeks, yeah. That's at five milligrams.

So when you're taking a little longer, you get 13, 14, but you're probably ballparked about 650. And the supplies, the vials, and the syringes and all that kind of stuff is usually about 75 bucks. I don't know what you paid for that.

Julie Pratt (12:53)
Yes.

Yeah, it

was pretty inexpensive and I feel like I have enough syringes and vials for like eons. you know, Amazon, get the, I have tons and I feel like that was not cost prohibitive at all. So.

Matthew Weiner, MD (13:08)
it'll last.

And so we're

actually, using, there's a Canadian product that makes this process much easier and avoids the kitchen counter dose. ⁓ You're unfortunately not the first patient who's had a kitchen counter dose and we, you know, we've... ⁓

Julie Pratt (13:21)
Okay.

Mm-hmm.

Yeah.

Matthew Weiner, MD (13:34)
And you know, so this to me, I started this approach because patients were like, have these seven and a half milligram pens, and I don't know what to do. I can't take it. Don't make me take it. They're like, what should I do? Take it every like three weeks and be nauseous for a week? I'm like, no, let's do this. Let's give it a shot. And that's how it started. And then they're basically, you know, a lot of them were like, you're saving me a ton of money too. And so because even copays are often three or $400. So we've kind of moved

Julie Pratt (13:43)
Right? Right?

Mm-hmm.

Yeah.

Matthew Weiner, MD (14:04)
away

from this strategy truthfully with the new Canadian product that makes it a lot easier to do and avoids the kitchen counter and you don't have to purchase all the stuff and it actually ends up being substantially even cheaper. Most of our platinum patients pay between the program fee and the meds, they pay about 250 bucks a month.

Julie Pratt (14:06)
You

I'll have to do that on my next round.

Mm-hmm.

Matthew Weiner, MD (14:30)
between the cost of it and the program is a little more expensive the first few months and then it drops in price. But the medicine is cheaper the first few months because you're taking lower doses and so it ends up being in a range. I'm not saying that's cheap but it's an amount that most people, at least probably around half the country could wrap their mind around.

Julie Pratt (14:51)
Great.

Zoë (14:52)
Well, especially if you compare that to compounded, right? Most places where people would be going to, whether it is a med spa or whatever the place may be that they're getting their compounded medications from, it's sometimes much more expensive than that.

Matthew Weiner, MD (14:56)
Yeah.

It is

much, mean, four and $500 is what we were selling.

Julie Pratt (15:06)
Right. And that was

Zoë (15:08)
Right.

Julie Pratt (15:09)
what I had done the math on as I started when I was weighing it out after my first meeting with you guys is I went with the like, well, this is a little bit cheaper already than the compounded. And with that, with the program, I can have, you know, as many appointments as I need to combat the problems I'm having with and to help with the dietary part with people who this is what you do for a living where my doctor is wonderful as she was, and she was super supportive.

⁓ I would say, what do I do when this happens? And she was like, ⁓ I'll do some reading. this isn't my specialty. I don't know. And so I think it's been a great help that I can put something in the app and say, I'm not feeling great with this. think then you had told me, because I think in one of my appointments, Dr. Weiner had said, one week I tend to have a little bit more side effect, and the next week I am hungry.

and it was kind of a weird and you were like, well just do your numbers, you know, adjust just a little bit. Do like three and a half or four and then do five. Like play with that on that week and that's huge for me.

Matthew Weiner, MD (16:15)
I think empowering patients to adjust their dose, massively, not 2.5 to 5, but the little tweaks of 3.5. First of all, will tell you just from a psychological perspective, there's something very valuable about feeling like I am in charge of how I feel. And I have some autonomy and ability to make adjustments that will improve the way I feel. When someone's like, can't do that,

Julie Pratt (16:21)
Sure. No.

Matthew Weiner, MD (16:45)
You know, you're like, I feel like it'd be so much better if my dose was higher or lower. Like that's frustrating and that often will just even magnify some of the impact emotionally. And so I found that just from an emotional perspective, giving patients control over this process is critical. And then the other thing is, you know, we meet every six weeks or so. ⁓ I don't know how you feel every day. You can tell me, but nobody knows how you feel better than you.

Julie Pratt (16:56)
Great.

Matthew Weiner, MD (17:15)
And so this kind of sliding scale-ish approach, it's something that you really, it's not something, I would never start it on the first visit, but if somebody gets more and more comfortable with the medication, then they're gonna have a really, better ability than me to make those kind of micro dose adjustments that's really helpful.

Julie Pratt (17:24)
Sure.

Mm-hmm.

Matthew Weiner, MD (17:36)
you mentioned some other positive side effects besides the weight loss. us about that a little bit more.

Julie Pratt (17:37)
Mhm.

So I had mentioned a little earlier that I was diagnosed with PCOS and I took form in most of my adult life. ⁓ And that was discovered when I went off birth control to try to get pregnant for the first time in my mid to later twenties. ⁓ I always struggled a little bit with weight as like a teenager, young adult through college. I was never huge, but I struggled with weight and I did a lot of like working out when I ate wrong to like

make that up. And I did a lot of like very unhealthy diet things as a teenager like, I feel like I don't want to go to the beach with my friends in my bathing suit because I have the biggest thighs so I won't eat this week, right? Like as a teenager, like I did a lot of very detrimental things to my body as a teen. When I went off birth control as a young adult to get pregnant, then I instantaneously gained a ton of weight, like 40 pounds within a very short period of time. ⁓

Matthew Weiner, MD (18:38)
Wow.

Julie Pratt (18:41)
And nothing changed. I just kept gaining and I couldn't figure it out. My cycle was off. I was not having periods. I was struggling. So after about a year or over a year of trying to get pregnant and not having cycles and gaining weight, they sent me to a specialist. They started doing all the normal infertility things until I actually had heard like an NPR thing about PCOS. And I was like, gosh, this is all my symptoms, right? This is all the things like I had.

hair growth, haven't felt well, all kinds of things. So they started treating me for metformin and as soon as I started metformin, I got pregnant. ⁓ I had an amazing OB specialist that ⁓ felt very strongly about staying on metformin permanently because he felt like that hormone balance for all my adult life, whether trying to get pregnant or not was important ⁓ for pre-diabetes and all the other endocrine pieces to that. ⁓ And so I did.

Matthew Weiner, MD (19:13)
All right.

Julie Pratt (19:39)
It never did a thing for me for weight loss. I never lost weight. So I continued as an adult to struggle terribly with weight. ⁓ I tried just about every diet on the books. Like if you name it, I've done it from shakes to starvation to every intermittent fasting to keto to everything I've done. I could always get down to about 190 pounds and then I would change absolutely nothing and my weight would just creep right back up.

Matthew Weiner, MD (19:59)
video.

Julie Pratt (20:09)
⁓ and I couldn't figure out what was happening. I was also in that span of time struggling with severe fatigue, ⁓ which all the doctors would say was because I was busy at a young mom and ran a business and whatever. And I refused to believe that, I forced myself to exercise on a very tired, tired, under nourished body for years, thinking that would help my weight. ⁓ I worked with probably three different dietitians over that.

period of time who would like say, I mean, unless you're making this up in your food logs, I can't figure out a reason you're not losing weight. And I'm like, I'm not making it up because I mean, I clearly say like when I eat chocolate or drink a Coke, like, you know, like I otherwise it would be perfect otherwise, right? I just like honest, right? But I was doing all the things, struggling with exhaustion, struggling with weight loss or weight gain.

Matthew Weiner, MD (20:53)
You do fess up at times. ⁓

Julie Pratt (21:06)
And then I was having severe migraines and I was also struggling with pain, like joint, significant joint pain was ultimately diagnosed first with lupus and they took that diagnosis away and diagnosed me with fibromyalgia. I don't know what the cause of my inflammation is or where that came from, but I can say my inflammation has reduced so significantly on this GLP-1 that I have next to no joint pain.

and no pain in my, I would have such bad pain in the tops of my thighs that if we were driving the car, my husband would reach over and pat my leg, like that it would make me jump. hurt so bad. ⁓ And that is completely gone. In the months that I would stop taking the GLP-1 when my insurance would deny, that pain would instantaneously come back. Within a week, I was back with joint pain. So that alone has been

Matthew Weiner, MD (21:50)
Wow.

I'm grateful.

Zoë (21:59)
Thank

you.

Julie Pratt (22:05)
Even if I wasn't losing weight, which I'm happy I am losing weight on it, even if I wasn't losing weight, the effect on my body pain has been amazing. My migraines are pretty much gone. I get them on a rare occasion, but ⁓ I take no migraine medication and I don't keep backup excedrin migraine in every person, every car that I ride in because I just don't get them anymore.

Zoë (22:22)
I'm.

Julie Pratt (22:33)
And then the other amazing side effect is my hot flashes and sleep from perimenopause are better. So I don't know why or how ⁓ and what the chemistry of that is with this medication, but it is a better inflammation.

Zoë (22:40)
Wow.

Matthew Weiner, MD (22:49)
I think it's inflammation. You these meds are well

known to be anti-inflammatory. ⁓ That's probably the primary mechanism of the cardiovascular risk reduction, of the reduction in dementia, and probably in the reduction of cancer too. You know, there's I think five or six cancers, ⁓ breast cancer, ovarian, pancreatic, colon cancer. ⁓

that all we see reduce risks in patients on these medications. And it's probably just because chronic inflammation creates a lot of problems. It creates heart disease, it creates cancer, it creates dementia. And so I think that you're really, you clearly had some kind of inflammatory response. My opinion, you know, after doing this for so long, is your story is so common. There's so many people out there, I bet you, as you're telling

your story and people are listening to this podcast there are so many people just shaking their head saying yes I feel that too that's how I feel that's how I feel my god I have that same problem there's so many people out there and I think that what we are seeing is that there is a certain genetic phenotype genotype I guess and that genotype results in a significant inflammatory response

from our processed foods, something in the food, in the gluten, the artificial sweeteners, the processed crap, the corn syrup, whatever. mean, list of ingredients that you could come up with that could cause this is a mile long. But there's something in our food chain that just doesn't react well with people and they become inflamed and they store fat unnecessarily. And we really have this kind of toxic response

to hyper-processed foods. ⁓ And these medications reduce that inflammatory response and trigger satiety and prevent the metabolic slowdown we typically see. Every time you try to lose weight, you lose weight and then your metabolism would come to a grinding halt and the weight would come back immediately. These meds block that response to calorie restriction that you'd seen in the past. And so there's something here and we've kind of, think we've

kind of stumbled into it almost like Fleming stumbled into penicillin. ⁓ Like, you know, we thought it was going to be about weight and that was certainly the most dramatic and important thing we saw in diabetes, but there's so much more there. ⁓

Julie Pratt (25:16)
right?

Matthew Weiner, MD (25:27)
And so I think that's, know, we just, I feel like we just figured something out and we don't understand exactly why. And as we dig more and more into why, we're going to come up with a better understanding of so many medical problems. And that's going to be really exciting.

Julie Pratt (25:45)
The other thing that I, the improvement, and because I don't feel like mental health is talked about enough and menopause, I feel.

motivated or passionate about saying these things out loud, right? Because I think my generation just didn't talk about it. I'm always impressed with my kids' age generation when they, I call people for interviews, like 20 year olds are like, I can't do Wednesday, I'm at counseling. I'm like, am I generation when I never said that, right? So I think it's great. But ⁓ I have also been on anxiety meds the majority of my adult life. I manage anxiety with exercise too. Like I did work out to like help that feeling. I tend to be a pretty amped person.

Matthew Weiner, MD (25:58)
Let's fly.

Julie Pratt (26:25)
and that's helpful to me. It helps me get a lot done too, but I tend to be a pretty amped person. ⁓ I have cut my anxiety medication in half since the GLP one as well, and that's the first time I again don't understand the chemistry to that. Whether it is all an impact of like I'm not having hot flashes so I'm sleeping better. I'm fueling my body in a different way so all the systems can actually work together and that is impacting my ability to

Zoë (26:34)
I

Matthew Weiner, MD (26:34)
Awesome.

Yeah.

Julie Pratt (26:56)
to manage my anxiety independently without medication better. I really don't know how it all plays together, ⁓ but that has been huge to me too.

Matthew Weiner, MD (27:06)
Yeah.

Zoë (27:07)
And

I would think that a big piece of that would also come from the decreased food noise, not playing into that extra anxiety that is usually associated with making decisions around food or trying to quiet that. Do you agree with that?

Matthew Weiner, MD (27:12)
home.

Julie Pratt (27:22)
I do and prior to taking a GLP-1, even up to the beginning of taking my GLP-1, I remember talking to my doctor when she first prescribed it. She asked me about the food noise and I said, I don't have any food noise. ⁓ And she would say, are you sure? I'm like, yeah, I don't like people talk about being obsessed about what they're eating next and stuff. I don't have that. And she was like, okay, until I didn't have it. And this is the first time in my life that I have eaten because I need fuel for my body and can choose what my body

needs for fuel versus being absolutely obsessively thinking about not from for me it was not an aspect of when do I get to eat next door I'm hungry and I want to eat but it was like what am I going to eat that isn't going to make me feel like crap what am I going to eat that isn't going to make me gain weight how am I going to eat but then also exercise and then I'm going to be over on calories and if I don't eat now that I'm hungry like that type of obsessive food thought was more what I felt I didn't

I had very strong cravings for sweets that have gone away. ⁓ But I'm a pretty determined personality and I would force myself through those cravings. Like I don't need it, I don't need it, it's better for me to not have it. I could get through that where now I'm like, something sweet sounds good. And I'm like, but I eaten in a while. I'm gonna have some protein, I'll have some fruit that cured it. Sometimes I'll have like chocolate, like my husband brought home some.

peanut butter cups the other day, I would have devoured that bag historically. I had two small Reese's peanut butter cups. I was like, that was delicious. And I'm totally good. I don't want anymore. And that's the first time in my life I have been able to do that and not obsess about how I'm going to manage my food, ⁓ which is hugely liberating.

Zoë (29:08)
really liberating.

Julie Pratt (29:11)
My nutritional strategy right now, I try to get at least 100 milligrams of protein. If I can get more, do, but I also find to get more, have to do a lot of like supplementing and shakes and stuff. And that starts to make me feel like I'm in a weird spot of things, detrimental things I've done to my body before. So I find that 100 milligrams and Zoe, think you and I talked about this in my first consult with you of like, doesn't need to be so high. Like bring it to a, we met on that.

Zoë (29:38)
I think when we first talked

to her, like, it was at like 150 grams of protein or something like that. And I was like, we don't, we don't need quite that much.

Julie Pratt (29:46)
Yeah,

so I try to do protein and a fruit or vegetable at every meal. ⁓ My most recent strategy has been to double the amount of fruit and vegetable that I have at every serving of that. So if I was going to have some grapes to have twice as many grapes, if I'm going to have carrots and hummus with lunch to have twice as many carrots. And then I do do carbs like in rice and those kinds of things that has been something I have chosen to do to ⁓

Zoë (29:58)
Good.

Julie Pratt (30:16)
eliminate some of the negative factors I have around food from, you know, carb cutting and stuff in the past is that I'm trying to let myself eat as what I want and just trying to limit some of those processed foods, but primarily it's the hundred grams of protein and doubling up my fruits and vegetables and then water is my big one. I do still do one diet coke a day. I can't seem to cut that habit, but I'm trying to get rid of that one too.

Zoë (30:19)
Mmm.

Matthew Weiner, MD (30:40)
Thank

Zoë (30:45)
Well, it sounds like the changes that you've made, not just from a fueling your body perspective, but from a healing your relationship with food perspective, I think that is very powerful and something that takes work and energy and intention, but you're putting in that effort. And I'm glad to hear that that's something that you're actively seeing an improvement with as well, because we have to eat for the rest of our life. And given the fact that you've been dieting for, you know, like you mentioned,

at the beginning, you know, for your entire adult life, now to be able to take away that preoccupation and not feel like you have to be dieting or staying under a certain number of calories, but more so making those mindful decisions for what your body needs.

Julie Pratt (31:30)
Mm-hmm. has been hugely, like he's liberating the great word for it. That's been hugely liberating. It's also been really liberating to not ⁓ food log and calorie count and weigh every single thing I'm eating, because I think I did that for a solid five years. And it's just not normal. Like Zoe, you and I talked about that. Like it's just not normal, right?

Matthew Weiner, MD (31:47)
Wow.

Zoë (31:47)
Mm.

Julie Pratt (31:54)
And I would get so frustrated at this like, I'm counting and weighing everything. My macros are exactly where a dietician said. I've strength trained. I've done my cardio. I went up in weight this week, right? Like that would be what would happen pre-JLP one. And it was like a maddening, like vicious cycle of like, of not succeeding. You know, like that just like what that does to our mental state for people who fight with weight. Like what that does,

constant like try, try, try, fail, try, try, try, fail is like unbelievable. ⁓ and so when I first went on the GLP one to make, to like sort of help my mind, what I did was continued on with my macros and my workout program that I knew did not work for me to lose weight, but was what was recommended by everybody. Mostly just to say to myself like, Hey, you know what? You were doing it right.

Matthew Weiner, MD (32:37)
you

No.

You ⁓

Julie Pratt (32:52)
your body couldn't do it. Like you were doing a good

Zoë (32:55)
Mm.

Julie Pratt (32:56)
job, you were succeeding, you just couldn't release the weight, right? And so that was huge for me, like as an affirmation to myself and my own mental health around food and relationship with food to go, ha, when I did that and I'll look at this, I'm losing two pounds, one pound, I feel great, you know, to go, I was doing it, I was doing all the work and our society put such an assumption on

if you're overweight, that you're just not doing the work. And I remember saying to my doctor one time, she was like, well, sometimes you have to increase your activity. And I said, so this summer I did a triathlon in a 25 mile height. I think I'm active. Like I don't think activity is the reason I'm fat, right? And so it's now to have that where I'm actually working out less because I feel like I also had an unhealthy.

Matthew Weiner, MD (33:36)
Thank you.

Julie Pratt (33:51)
relationship with working out because of my weight. I work out less, more effectively and eat more and I'm losing weight.

Matthew Weiner, MD (34:00)
I love that you did that, that you ate the same exact thing to show yourself. But you know, the thing that I kind of hear and you really didn't have that much, you probably pushed GLP-1s away for maybe a year at most from when they were available to you. But you know, there was 30, 40 years of self-flagellation over your weight, right?

Julie Pratt (34:00)
is.

Mm-hmm.

Correct. Yeah.

Matthew Weiner, MD (34:28)
despite the

Julie Pratt (34:28)
Yeah.

Matthew Weiner, MD (34:28)
fact that you were trying harder than anybody else.

And so I think, you know, what have you learned from all this? This has been, you know, I think you and I are very similar in age. We actually have the same birthday. I'm a few years older than you, but we do have the same birthday. ⁓ And so, you know, we're both kind of getting up there. Our kids are getting older and we're starting. think I feel like I'm finally getting maybe a little bit wiser. I don't know. ⁓ What have you learned from all this? This is, you know, what from your lifetime of your struggle with your weight? What are your take home messages? How do you think different?

Julie Pratt (34:41)
Yep.

Yeah.

Matthew Weiner, MD (35:03)
differently now.

Julie Pratt (35:05)
I think

there's a huge element for me of ⁓ relief, I guess, if that's the right word, of that it was not my fault, for lack of a better way to say that. I felt like I knew that most of my life, I would have these conversations with friends and family or whatever. I'd have a

friend who's like skinny as a rail and she's like downing a bag of potato chips while we're talking and I'm like, how come I'm gaining weight and you're not? And she'd be like, I don't know, you eat another chip, right? I think I learned that I, to like pay, that I do know my body, that I do know something was wrong and that I didn't trust myself to push more on that.

go to a specialist or do something else. I just kept letting the norms of thinking it was what I was doing be wrong. think knowing that I can trust my intuition about my own body has been huge. With that, ⁓ I know what was working and not working for my body, and I know how hard I was working. So that's been a huge part. ⁓ The other part is I think I finally

truly know that it is not calories in calories out and exercise that that is the Culprit, mean sure it is for some people right like some people are you know doing yeah, you know ⁓ but it is not all just about calories and calories out and that our entire body system is at play in this so it isn't just about what I'm the amount of calories I'm putting in my body. There's I think the inflammation piece you touched on

Matthew Weiner, MD (36:43)
Yeah, naturally thin people.

Julie Pratt (37:01)
was a huge part of like why my body couldn't correct course on its own because and release any fat regardless of what I was doing. ⁓ So those have been my two biggest things I think that I've learned.

Matthew Weiner, MD (37:15)
I think that...

Zoë (37:16)
It's huge.

Matthew Weiner, MD (37:16)
You know, your story about just how hard you tried, how much effort you put in throughout your life. I'm sure Zoe would agree is just something we hear over and over and over again. And you know, when I first came out of residency and you know, when I was younger, I was like the rail thin and I could eat whatever I wanted. And I kind of, you know, and even in my surgery residency, the limited experience I had with bariatrics ⁓ was very much along like, these patients

just can't control themselves and it's an emotional thing and you know the site console they really got to make sure they do a thorough site console and because they got to be crazy if they're overweight and and that was kind of how I started my career and then as I kind of got into it more and more I was like either these people are all waiting in the parking lot together and like getting their story straight or like

Julie Pratt (38:10)
Right?

Zoë (38:10)
That's

it.

Matthew Weiner, MD (38:12)
There's

something here, like everybody tells me the same thing. They all eat way better than I do and they all exercise more than I am and yet I'm 100 pounds lighter than them and what's going on here? And as I started to learn more and more about it, you know, and then it became very frustrating to me because then I had this great tool and I got really good at bariatric surgery and we could do it really safely but...

Julie Pratt (38:22)
Mm-hmm.

Mm-hmm.

Matthew Weiner, MD (38:36)
we were seeing 1 % of all people who qualified for this procedure actually choose bariatric surgery. And I get it, like, you know, don't, it's not like I think every single person who's overweight should have surgery by no means. But that was the majority of my career was like, we got, you gotta go through this kind of rough thing, surgery, to solve this problem that's not your fault, but it's just causing you so much pain and suffering.

Julie Pratt (39:02)
Mm-hmm.

Matthew Weiner, MD (39:02)
And so

now we have the meds and that 1 % is just increasing exponentially. And you know, now it's, think 15 % of people have tried a GLP-1. And I think when the cost comes down, we're going to see that everybody who's overweight has tried one at one point. And so that to me is just so enlightening that we now have these treatments that we can get out to as many people as possible and to help people who are suffering because the pain is real.

Julie Pratt (39:19)
Mm-hmm.

It is. And I also think like I was never a person like I didn't feel terrible about myself, like overweight. I didn't feel like I looked horribly disgusting and I couldn't stand myself or anything like that. My husband never said a word about my weight. it wasn't that's never been an issue from like a vanity standpoint for me. But the things that bothered me were like comfort.

Matthew Weiner, MD (39:33)
Very real.

Julie Pratt (39:59)
Right? Like it's uncomfortable to sit in an airplane seat at 225 pounds. It is uncomfortable to do a triathlon at 220 pounds, right? Like on a five foot three frame. And that's what I am. Right? Like, so it's uncomfortable to bend over and not be able to get my gut out of the way to tie my shoes. Those were the things that drove me nuts. And then I started thinking about like my future of like,

I want to run around and chase my grandkids. My mom's incredibly active. She's 77 years old and she hikes 20 miles with me at a time. I want to be able to do that. And the more and more overweight I was, the more uncomfortable things that were happening between joint pain and being hot, not being able to get comfortable, those types of things were a bigger issue for me than how I looked. Now, I'm not going to lie. I love that I look

better. And I bought for the first time since pre-children a size 10 jeans yesterday and that was huge. But again, there is more to it than like the size of pants, right? And that's what I feel like. Initially when I went on the GLP-1, I was like, I'm going to tell nobody I'm on this medication. That was my thing. When people ask me, I even had like a little elevator speech. Someone says, how are you losing weight? I'm going to say,

Matthew Weiner, MD (41:02)
Love it!

Julie Pratt (41:26)
all the things, I'm doing everything, food, exercise, trying to focus on my rest, I'm doing all the things, then I'm not lying, right? But I'm not disclosing that I'm on this medication ⁓ until all the other good came to me. And then I was like, I feel like people need to know that this is an okay option and we have to get rid of the stigma behind all of the overweightness and using a medication. And I just have really

Matthew Weiner, MD (41:28)
Yeah.

Julie Pratt (41:56)
I was on Metform in all my adult life. Why was that okay in my head? I didn't keep that a secret. Like I didn't, you ⁓ and so that's been a huge thing for me of like, of feeling like I want, I'm okay with that. So when people ask me now, I say, I'm on a GLP-1 and I'm doing all the things, you know, like.

Zoë (42:13)
Yeah.

Matthew Weiner, MD (42:15)
And that's the item.

Zoë (42:15)
Wow. And I think you saying that is really powerful because I'm sure, you know, I know just by talking with people and I'm sure so many of our listeners hearing your story, they can relate to you so much. And, know, you making the decision to help play your part in letting go of the stigma and being here and sharing your story on the podcast. just really want to thank you. And I'm sure everybody listening.

Matthew Weiner, MD (42:20)
I'm to try.

Zoë (42:41)
is super grateful to you as well for sharing.

Julie Pratt (42:45)
I appreciate the opportunity and the support and that opportunity to talk and tell my story.

Matthew Weiner, MD (42:51)
Thank you. Yeah, we've loved being part of your journey, Julie. You deserve this success. You really do.

Julie Pratt (42:55)
Thanks.

Thanks. I'm excited about it. And I'm excited to get to my next goal. The goal I'm at is the weight I was at my first pregnancy, which was 23 years ago. My son just turned 23. Well, 24 then. guess if it was pre-pregnancy, right? My next goal is to try to get down to what I was when I started grad school, which was 165. So that's my next trying. Yeah. We'll get there.

Matthew Weiner, MD (43:21)
We're gonna get you there.

Zoë (43:21)
Well, yeah, well, we'll

keep in contact with you. you know, because, you know, of course you're in the platinum program. So we'll be talking with you and having appointments with you ongoing and can't wait to celebrate that next milestone with you.

Julie Pratt (43:35)
Awesome. Thank you so much.

Matthew Weiner, MD (43:37)
All right, good to see you, Julie. Thank you.

Zoë (43:37)
Thanks, Julie.

Julie Pratt (43:39)
Alright, have a good night.